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INTRO TO CLINICAL > HANDOUTS FOR EXAM 1 > Flashcards

HANDOUTS FOR EXAM 1 Flashcards

1
Q

Chinese traditional medicine over _____ yrs ago

A

5000

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2
Q

The ______ (Mesopotamia/today ____/____) and Europeans knew about disease states and had ______ and ______

A

The Sumerians (Mesopotamia/today Syria/Iraq) and Europeans knew about disease states and had healers and specialists

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3
Q

Sumerians believed that diseases were cause by what four things?

A
  1. bad spirits
  2. worms
  3. intestinal decay
  4. punishment from the gods (*)
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4
Q

_____ generally considered the cradle of modern _______ medicine

A

Greece generally considered the cradle of modern Western medicine

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5
Q

Greek medicine moved away from “supernatural” to what 3 things?

A
  1. natural causes
  2. observation
  3. logical thinking
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6
Q

Greek medicine revolved around what?

A

the four “humors”

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7
Q

What are the four “humors”

A
  1. blood
  2. phlegm
  3. yellow bile
  4. black bile
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8
Q

who is Imhotep? what did he do? and what was his professional title?

A

Pyramid builder and physician to the pharaoh. He made sure the pharaohs could poop properly
Professional title: “Shepard to the anus”

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9
Q

what did Hippocrates do and what is he credited with?

A

Founded a school of physicians and is credited with the Hippocratic oath.

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10
Q

what is the earliest known writing on medicine

A

Edwin Smith Papyrus

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11
Q

who is speculated to be original author of the Edwin Smith Papyrus

A

Imhotep

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12
Q

what are the 3 things the Edwin Smith Papyrus includes information on

A
  1. trauma surgery
  2. anatomy
  3. diagnosis and treatment of 48 medical conditions including heart failure
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13
Q

Imhotep rejected “____” in favor of ______ for healing

A

Imhotep rejected “magic” in favor of science for healing

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14
Q

What are the 3 main things the hippocratic school taught?

A
  1. taught careful observation
  2. careful reporting of symptoms
  3. use of observation for prognostication
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15
Q

What did Aulus Celsus do?

A

identified the cardinal signs of inflammation

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16
Q

What did Claudius Galenus do?

A

Worked as physician to Roman gladiators.

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17
Q

What were the 6 things Galen was the first to describe
1. Arteries are filled with ____ instead of “______” ____
2. Urine is produced by ____
3. Spinal cord and spinal nerves control _____ ________
4. the ____ is the origin of blood vessels, ______ is origin of nerves
5. ______ nerves are different from motor nerves
6. couldn’t do ______ on humans so he got facts wrong (studied ______)

A
  1. Arteries are filled with blood instead of “pneuma” air
  2. Urine is produced by kidneys
  3. Spinal cord and spinal nerves control muscle function
  4. the heart is the origin of blood vessels, brain origin of nerves
  5. sensory nerves are different from motor nerves
  6. couldn’t do autopsies on humans so he got facts wrong (studied monkeys)
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18
Q

medicine did not advance beyond teaching of Galen until what period?

A

Renaissance

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19
Q

what did Leonardo da Vinci learn from medicine?

A

learned from human dissection about the functions of muscles, bones, and tendons

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20
Q

what did William Harvey do?

A

discovered that the blood is moved through the body by the heart (famous book ‘De Motu Cordis er Sanguinis’

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21
Q

Rudolf Virchow introduced what concept

A

introduced the concept of cellular pathology - diseases arise from alterations within cells and tissues using microscopic observation

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22
Q

what did Edward Jenner do?

A

introduced first systematic vaccination and discovered that cowpox could protect against smallpox

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23
Q

Ignaz Semmelweis established what

A

that sanitary conditions in surgery and the healthcare settings saves countless lives

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24
Q

Ignaz Semmelweis compared ________ fever in _____ wards staffed by _____ vs. ____ and medical students

A

Ignaz Semmelweis compared childbed fever in maternity wards staffed by midwives vs. doctors and medical students

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25
Q

who became known as the “savior of mothers”

A

Ignaz Semmelweis

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26
Q

who is the founder of modern bacteriology

A

Robert Koch

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27
Q

what did Robert Koch discover

A

causes of tuberculosis, cholera, and anthrax

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28
Q

what 3 principles did Louis Pasteur discover and what vaccines?

A

principles of vaccination, fermentation, and pasteurization (clean milk), discovered first vaccines for rabies and anthrax

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29
Q

who is the first “cellular pathologist”

A

Rudolf Virchow

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30
Q

what is Rudolf Virchow frequently called

A

“Father of modern Pathology”

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31
Q

what is Rudolf Virchow credited with

A

first recognizing leukemia

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32
Q

what is Virchow’s node

A

enlarged supra-clavicular lymph node as early signs of gastric cancer

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33
Q

Rudolf Virchow discovered ______ ______ and coined the term ______

A

discovered pulmonary thromboembolism and coined term embolism

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34
Q

who is the father of psychoanalysis

A

Sigmund Freud (1st shrink)

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35
Q

who is the father of antiseptic surgery

A

Sir Joseph Lister

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36
Q

Joseph Lister used _____ to sterilize _____, _____, and _____

A

phenol to sterilize instruments, wounds, and dressings

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37
Q

what did George Papanicolaou discover

A

that vaginal smear could detect uterine cancer

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38
Q

who was a pioneer in early cancer detection

A

George Papanicolaou

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39
Q

what did Sir Alexander Fleming discover and what did he research

A

discovered penicillin and did research on lysozyme

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40
Q

what did Sir Alexander Fleming notice in 1928

A

mold (Penicillum notatum) inhibited the growth of Staphylococcus aureus on a culture plate

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41
Q

diseases are usually detected if they cause ____ and ____

A

signs and symptoms

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42
Q

what are 3 examples of signs

A
  1. fever
  2. high blood pressure
  3. bleeding = can be seen by doctors, detected by clinical tests (EX: X-ray)
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43
Q

what are 3 examples of symptoms

A
  1. pain
  2. drowsiness
  3. vertigo = reported by patient (cannot be measured)
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44
Q
  1. some diseases are pre-_____
  2. some disease are ______
  3. some diseases can be _____ by ____
  4. some diseases may be visible only with _____ ___, _____
A
  1. some diseases are pre-determined
  2. some disease are acquired
  3. some diseases can be seen by eye
  4. some diseases may be visible only with medical tests, imaging
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45
Q

what is an example of pre-determined disease

A

genetic defect (gene mutations)

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46
Q

what is are three examples of diseases that are acquired

A
  1. infection
  2. trauma
  3. degenerative
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47
Q

what is an example of a disease that can be seen by eye

A

jaundice

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48
Q

what are examples of disease seen medical tests and imaging

A

pigment or inclusions visible in cells by microscope, urine protein

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49
Q

what are the four pillars to understanding disease and their order

A
  1. Disease etiology
  2. Pathogenesis
  3. Lesion
  4. Functional Changes
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50
Q

what is disease etiology and examples

A

causes of a disease
infection, injury, genetic defects

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51
Q

what pillar is this an example of streptococcus pneumonia infection of the lungs

A

disease etiology

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52
Q

what is pathogenesis

A

disease process (pathogenic mechanism)

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53
Q

what is pillar is this an example of streptococcus infection of the lung leads to lung damage, inflammation, and fluid acclimations

A

pathogensis

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54
Q

what is a lesion

A

morphologic changes/ultrastructial: structural changes I the affected tissues

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55
Q

what pillar is this an example of “bacterial pneumonia leads to lobar consolidation, inflammatory infiltrates, and lung edema”

A

lesion

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56
Q

what is functional changes

A

impaired function of an organ system = clinical manifestation

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57
Q

what pillar is this an example of “lobar bronchopneumonia, fever, pain, malaise, possible death”

A

functional changes

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58
Q

What are the 5 ways you recognize diseases and what is their order

A
  1. Reported by patient (pain, nausea)
  2. Gross examination
  3. Histologic exam
  4. Lab exam
  5. Specialized exam
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59
Q

what is a gross exam

A

alteration (lesion) is visible to the naked eye (physical exam, autopsy)

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60
Q

what is a histological exam

A

alterations visible by microscope

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61
Q

what are 3 examples of lab exams

A
  1. blood tests
  2. urine sample,
  3. DNA test
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62
Q

what are 4 examples of specialized exams

A
  1. X-ray
  2. ultrasound
  3. endoscopy
  4. magnetic resonance imaging (MRI)
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63
Q

a diagnosis begins with what

A

observation

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64
Q

what physicians recognized disease

A

old physicians

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65
Q

what are the four cardinal signs of acute inflammation that Celsus founded

A
  1. Calor (heat)
  2. Dolor (pain)
  3. rubor (redness)
  4. tumor (swelling)
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66
Q

what is the fifth sign of cardinal signs that Galen founded

A

functio laesa = impaired function

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67
Q

how many hours is the 1st phase of acute inflammation? what is it? what cardinal signs (CS) are present

A

0 - 4 hrs
preformed factors: antibodies, complement, serum, vasoactive factors
CS: Rubor (redness) and Calor (heat)

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68
Q

how many hours is the 2nd phase of acute inflammation? what is it? what cardinal signs (CS) are present

A

4 - 48 hrs
influx of neutrophils
CS: Rubor (redness), Calor (heat), Dolor (pain), Tumor (swelling)

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69
Q

how many hours is the 3rd phase of acute inflammation? what is it? what cardinal signs (CS) are present

A

24 - 96 hrs
influx of macrophages
CS: Rubor (redness), Calor (heat), Dolor (pain), Tumor (swelling), Functio Laesa (impaired function)

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70
Q

how many hours is the 4th phase of acute inflammation? what is it? what cardinal signs (CS) are present

A

> 96
adaptive immunity: T lymphocytes are activated and migrate to inflammatory site
CS: Dolor (pain), Tumor (swelling), and functio laesa (impaired function)

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71
Q

CASE OF THE DAY: KNUCLE PHOTO
- swelling, scabs/scrapes/abrasions/pinky knuckle hard to see

WHAT IS THE DIAGNOSIS

A

Boxer’s fracture / Bar Room fracture on hand bone (pinky knuckle)

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72
Q

what are the four things we do to arrive at a clinical diagnosis

A
  1. Information about current illness/problem of patient (IS IT EMERGENCY / LIFE THREATENING)*
  2. patient history
  3. physical exam
  4. diagnostic tests
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73
Q

what are the 5 questions you ask a patient about a current illness

A
  1. when did the symptoms/signs start? circumstances?
  2. is this the first time the patient has had these symptoms
  3. are these symptoms getting worse, better, or remain stable?
  4. what steps did the patient take? Did anything help or change?
  5. if the patient had this in the past is there a significant change?
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74
Q

what are 3 other patient issues that could be relevant to patient history?

A
  1. smoking
  2. alcohol, drugs
  3. social issues, employment, job less
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75
Q

what are the 5 main things you do for physical examination

A
  1. cultivate the art of observation
  2. be systematic in your exam
  3. develop a routine that you follow
  4. know your tools (stethoscope)
  5. future: mobile ultrasound devices
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76
Q

what is a non-invasive procedure and what are the three main examples

A

a procedure that does not injure the patient (does not break skin)
1. eye/ear/throat inspection, neurological tests of reflexes
2. urine test, throat swab
3. x-ray, ultrasound, MRI, CT, ECG

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77
Q

what is an invasive procedure and what are the four main examples

A

procedure that injures patient (breaks skin)
1. blood draw
2. spinal tap
3. biopsy
4. endoscopy

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78
Q

what are the 2 common blood tests

A

CBC (complete blood test)
CMP (comprehensive metabolic panel)

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79
Q

what are the 6 common lab tests

A
  1. plasma proteins (albumin, enzymes, immunoglobulins)
  2. antibodies (serologic tests)
  3. hormones (ex: thyroid hormones)
  4. Disease biomarkers (ex: for myocardial infarct, pancreatitis, liver disease, and renal disease)
  5. erythrocyte sedimentation rate = ESR (useful only for myeloma, temporal arteritis, poly myalgia rheumatica)
  6. Drugs
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80
Q

what 4 things does a urine lab test for

A
  1. protein
  2. microorganisms
  3. pH
  4. blood
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81
Q

what 3 things does a stool sample test for

A
  1. blood
  2. parasites
  3. fat
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82
Q

what 4 things does cerebrospinal fluid test for

A
  1. fluid
  2. cells
  3. proteins
  4. microorganisms
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83
Q

what instrument is used for a CBC (complete blood count)

A

sysmex analyzer

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84
Q

____ is routinely analyzed in medicine

A

blood

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85
Q

what are the 2 terms for when there is an increase in RBC (red blood cells)

A

erythrocytosis or polycythemia

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86
Q

what is the term when there is a decrease (not enough) in RBC (red blood cells)

A

anemia or erythroblastopenia

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87
Q

what is the term when there is an increase (a lot more) WBC (white blood cells)

A

leukocytosis

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88
Q

what is the term when there is a decrease in WBC (white blood cells)

A

leukopenia

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89
Q

what is the term when there is an increase in lymphocytes

A

lymphocytosis

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90
Q

what is the term when there is a decrease in lymphocytes

A

lymphocytopenia

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91
Q

what is the term when there is an increase in granulocytes

A

granulocytosis

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92
Q

what is the term when there is a decrease in granulocytes

A

granulocytopenia or agranulocytosis

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93
Q

what is the term when there is a increase in neutrophils

A

neutrophilia

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94
Q

what is the term when there is a decrease in neutrophils

A

neutropenia

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95
Q

what is the term when there is an increase in eosinophils

A

eosinophilia

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96
Q

what is the term when there is a decrease in eosinophils

A

eosinopenia

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97
Q

what is the term when there is an increase in platelets

A

thrombocytosis

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98
Q

what does an electrocardiogram (ECG, EKG) measure

A

electrical activity of heart

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99
Q

what is the term when there is a decrease in platelets

A

thrombocytopenia

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100
Q

what does an electroencephalogram (EEG) measure

A

electrical activity of brain

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101
Q

what does an electromyogram (EMG) MEASURE

A

electrical activity of muscle

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102
Q

what is an SA node

A

sinoatrial node

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103
Q

what is an AV node

A

atrioventricular node

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104
Q

what does a P wave represent

A

atrial depolarization

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105
Q

what does a QRS complex represent in a ECG strip

A

ventricular depolarization

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106
Q

what is a T wave represent in a ECG strip

A

depolarization of the ventricle

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107
Q

what are 3 things that are considered bad when measuring electrical activity

A

ventricular flutter
250-300 beats/min
sinusoidal waves

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108
Q

what is considered worse when measuring electrical activity

A

ventricular fibrillation: no clear electrical activity

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109
Q

what is used for CBC in medical charts

A

fishbone

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110
Q

what is the hierarchy of physician doctors

A

ordinary doctor < overseer of doctors < chief doctors < inspector doctors

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111
Q

who was instrumental in developing the four-humor theory

A

Hippocrates

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112
Q

who is considered one of the greatest physicians of all time.

A

Claudius Galenus

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113
Q

Rudolf Virchow encouraged his students to think “_____” and use _____

A

think cellular and use microscopes

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114
Q

Rudolf Virchow stated that the only source for a living cell is

A

another living cell

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115
Q

what is the term when there is a decrease in all the cell lines

A

pancytopenia

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116
Q

what years what Edwin Jenner active

A

1749 - 1823

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117
Q

what years was Ignaz Semmelweis active

A

1818 - 1865

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118
Q

what years was Robert Koch active

A

1843 - 1910

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119
Q

what years was Louis Pasteur active

A

1822 - 1895

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120
Q

what years was Sigmund Freud active

A

1856 - 1939

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121
Q

what years was Sir Joseph Lister active

A

1827 - 1912

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122
Q

what years was George Papanicalaou active

A

1883 - 1962

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123
Q

what years was Sir Alexander Fleming active

A

1881 - 1955

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124
Q

who advanced Greek medicine

A

Romans

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125
Q

Aulus Celsus was a roman what and what years?

A

writer and physician (30 BC - 38 AD)

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126
Q

Celsus translated the word cancer from “____” like growth described by the _____ (_______)

A

crab described by the Greeks (Hippocrates)

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127
Q

who wrote “De Medicina”

A

Celsus

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128
Q

what was the book “De Medicina” a book on? does it still exist?

A

a book on surgery, diet, pharmacy, etc. (still exists)

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129
Q

who’s writings guided medicine for 1,500 years into the Middle Ages

A

Claudius Galenus

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130
Q

who did Galen work for?

A

roman emperor Claudius Aurelius and his son

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131
Q

Imhotep is often referred to as the “one who…”

A

“the one who comes in peace”

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132
Q

what does the CMP test look for

A

electrolytes (Na, K, Cl, Ca), glucose, blood urine nitrogen (BUN), creatine (Crea), liver enzymes (AST, ALT), etc.

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133
Q

X-rays were discovered by who and in what year

A

Wilhelm Roentgen in 1895

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134
Q

what did Wilheim Roentgen work with in his lab and what did he discover

A

worked with electric beams (cathode-ray tube) and discovered that a fluorescent screen nearby started glowing

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135
Q

what did Wilheim Roentgen find out about X-rays

A

they could go through tissue, but not bones and metal, and could expose photographic film

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136
Q

what are X-rays and gamma rays

A

electromagnetic radiation (photons) similar to light but of much shorter wavelength and much higher energy level

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137
Q

light has a wavelength of…

A

6000 angstroms

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138
Q

X-rays have a wavelength of…

A

1 angstrom (0.1 nm)

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139
Q

gamma rays have a wavelength of…

A

0.0001 angstrom

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140
Q

what are X-rays and ionizing radiation measured in

A

Sievert (Sv)

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141
Q

what is Sievert used for

A

to measure the radiation dose to the human body

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142
Q

1 Sv = ?
1 rem = ?

A

1 Sv = 100 rem
1 rem = 0.01 Sv

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143
Q

what was X-rays and ionizing radiation USED TO BE measured in

A

rem (roentgen equivalent in man)

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144
Q

digitizing of X-ray images with what

A

photostimulable phosphor plates

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145
Q

excited electrons are trapped in?

A

phosphor “color centers”

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146
Q

what is a CT and what does it do

A

computed tomographic scan that uses noninvasive procedure such as x-rays

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147
Q

what does a CT use?

A

motorized scanner that circles around patient

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148
Q

what does a CT obtain

A

many serial x-ray images that are then compiled to a 3-D image

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149
Q

CT can reveal much more ___ than an ______

A

CT = more details than X-ray

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150
Q

what do individual scans of CT use

A

lower intensity x-rays

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151
Q

____ exposure is significantly higher with ____ than ____

A

X-ray exposure is significantly higher with CT than X-ray

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152
Q

what is used to enhance X-ray studies

A

contrast material

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153
Q

what occurs in nuclear medicine what are 2 examples

A

patients are injected with radioactive material that is then enriched in areas of highest activities

  1. Thyroid adenoma
  2. Metastatic cancer of thyroid
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154
Q

what is an MRI what does it do

A

magnetic resonance imaging that is noninvasive using magnetic and radio wave fields

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155
Q

what does an MRI use

A

strong magnet - no magnetic material in the room

156
Q

MRI machines are very…

A

noisy - patients get earplugs or headphones

157
Q

MRI is superior for viewing…

A

soft tissues

158
Q

MRI images can be weighted based on…

A

structure that they should enhance by timing of the RF pulse

159
Q

what is a T1 and T2 MRI

A

T1 = one tissue is bright = fat
T2 = two tissues are bright = fat and water (WW2 = water is white in T2)

160
Q

___ is better for anatomy and ___ is better for pathology

A

T1 = anatomy
T2 = pathology

161
Q

MRI can be used with what contrast material and what can it do

A

Gadolinium - enhances visibility of structures such as blood vessels

162
Q

What are 3 characteristics of T1

A
  1. Tissue with high water content will appear dark (grey)
    • fat, edema, infection
  2. Tissue with low water content will appear white/brighter
163
Q

what are 3 characteristics of T2

A
  1. Tissue with high water content will appear white/brighter
  2. Tissue with low water will appear darker (grey)
  3. World War II
    - water is white on T2
164
Q

what is a PET and what does it do

A

position emission tomography that injects radioactive material such as gamma rays

165
Q

what does an ultrasound use

A

uses a transducer to generate high-frequency sound waves (>20,000 Hz) to detect tissues in the body

166
Q

can humans hear the sound waves of an ultrasound

A

NO

167
Q

what do the soundwaves of an ultrasound generate

A

echo’s that are reflected back differently to the transducer because tissues in the body have different densities

168
Q

ultrasound (sonography) can be used for many human conditions such as…

A
  1. heart conditions
  2. blood vessels
  3. internal organs (etc.)
169
Q

ultrasound is _______ and works through the ____

A

painless and works thru skin

170
Q

what are biopsies performed to obtain and what are 2 examples

A

tissue for histological examination

  1. breast biopsy
  2. bone marrow biopsy
171
Q

what is histology

A

examination of tissue with the microscope. Tissue is intact and morphology preserved

172
Q

what is cytology and what are 3 examples

A

cells are recovered by various means. Single cells are usually recovered and tissue structure is not preserved

  1. Pap smear
  2. bronchoalveolar lavage (BAL)
  3. urine cytology
173
Q

what occurs in tissue processing

A

clinicians (or pathologists) remove tissue by needle or surgery and preserve it in a fixation or frozen for examination by the pathologist

174
Q

what occurs upon receiving the tissue during tissue processing

A

the pathologist inspects the tissue, describes the tissue, marks the tissue, and dissects the tissue

175
Q

tissues must be processed before sections…

A

can be obtained for histologic examination

176
Q

tissues are frequently embedded in

A

paraffin

177
Q

what is another way to process tissue called and how is it done

A

“frozen section” which is frequently done during surgery to give the surgeon fast information needed for his work

178
Q

what is frozen section

A

quick freezing of the tissue in butanol/liquid nitrogen

179
Q

____ must be stained for examination

A

sections

180
Q

sections must be stained with _____ before they can be ______ by the _____

A

sections must be stained with dyes before they can be examined by the pathologist

181
Q

what are the most common stains and what is their description

A

H&E (Hematoxylin and Eosin) are the most common stain.

Hematoxylin: basic dye and stains nucleic acid in the cell nucleus blue

Eosin: acidic stains the cytoplasm reddish/pink

182
Q

what do special stains do

A

help discriminate particular tissues

183
Q

what is PAS (periodic acid Schiff) staining

A

detection of glycogen in liver or muscle. Fungi also stain PAS positive

184
Q

what is a Masson’s Trichrome staining

A

collagen (for example liver cirrhosis)

185
Q

what are the three special stains

A
  1. PAS (periodic acid Schiff)
  2. Masson’s Trichrome
  3. Immunofluorescence staining
186
Q

what does a Immunofluorescence staining (IF) do what is an example

A

can specifically identify particular cell types, tissues, molecules

EX: Immunoglobins and complement in post-infectious glomerulonephritis

187
Q

living cells and tissues _____ to a changing _______ or _____

A

living cells and tissues adapt to a changing environments or stress

188
Q

failure of adaptive mechanisms lead to

A

cell injury or cell death

189
Q

cellular _____/_____ can be visible at the _____ or at the _______ level

A

cellular changes/injury can be visible at the organ or at the cellular level

190
Q

tissues can also show changes related to

A

aging

191
Q

________ or _______ changes to tissues are important for _________ diagnosis

A

Macroscopic or microscopic changes to tissues are important for pathological diagnosis

192
Q

what are 3 examples of macroscopic changes (organ level)

A
  1. Hypertrophy, atrophy, dysplasia
  2. Pigmentation, calcification
  3. Fatty change
193
Q

what are 3 examples of microscopic changes (cellular level)

A
  1. Pigmentation, inclusions (EX: iron, fat, lipofuscin
  2. Multi-nucleation
  3. Apoptosis, necrosis
194
Q

hyaline inclusions in the liver =

A

mallory bodies (ALCOHOL!)

195
Q

what is the tissue response to an increased demand or chronic stimulation

A

hypertrophy and hyperplasia

196
Q

what is the tissue response to an decreased demand, lack of stimulation

A

atrophy

197
Q

what is the tissue response to chronic injury

A

metaplasia

198
Q

what is hypertrophy

A

cells increase in size, organs may increase in size (in dividing and non-dividing cells)

199
Q

what is hyperplasia

A

increase in the number of cells (ONLY with dividing cells)

200
Q

what is atrophy

A

shrinkage in cell size (or organ)

201
Q

what is metaplasia

A

cells change from one cell type to another

202
Q

what is physiologic atrophy and the mechanism

A

shrinkage of the uterus after pregnancy

mechanism: loss of hormonal stimulation, developmental gene regulation

203
Q

what is pathologic atrophy and its mechanism

A

muscle atrophy after fracture, brain with Alzheimer’s

mechanism: inactivity, loss of innervation, loss of perfusion/blood supply, lack of nutrition, loss of hormonal stimulation, aging, pressure

204
Q

most body surfaces are lined by

A

epithelial cells

205
Q

what are the three types of epithelium

A
  1. SQUAMOUS = lining of body cavities (vessels, alveoli (lung))
  2. CUBOIDAL = lining nephrons, thyroid glands, surface of ovaries
  3. COLUMNAR = gut including stomach and large intestine, gallbladder, lining of uterus, upper respiratory tract
206
Q

epithelial cells form _____ layer (_____ epithelium) or ______ (_______ epithelium)

A

ONE LAYER = SIMPLE
SHEETS = STRATIFIED

207
Q

what is squamous metaplasia

A

upper airways = smokers

208
Q

columnar epithelium –STRESS–> ?

A

columnar epithelium –STRESS–> squamous epithelium

209
Q

what is intestinal metaplasia

A

gastro-esophageal junction = Barrett’s esophagus

210
Q

squamous epithelium –GERD–> ?

A

squamous epithelium –GERD–> columnar epithelium (glandular type)

211
Q

“fatal” stress = ?

A

CELLS DIE

212
Q

what are the causes of cell death

A
  1. oxygen deprivation
  2. physical insult (heat, cold, electric)
  3. chemical
  4. infectious
  5. immune
  6. genetic
  7. nutrition
213
Q

what is death by necrosis and apoptosis

A

necrosis = inflammation (enzymatic digestion and leakage of cellular contents)
apoptosis = silent

214
Q

what is a classical apoptosis sign

A

DNA laddering

215
Q

what is caspase

A

cysteine-aspartate protease

216
Q

what is laddering due to

A

capase-activated Dnase (CAD)

217
Q

CAD cuts DNA into

A

small fragments

218
Q

fragments are multiples of

A

280 bp (length of DNA wrapped around histones)

219
Q

what is the extrinsic apoptosis pathway

A

death receptor mediated apoptosis pathway

220
Q

what is the intrinsic apoptosis pathway

A

mitochondrial-mediated apoptosis pathway

221
Q

what is the third apoptosis pathway

A

endoplasmic reticulum stress pathway (mediated by too much or too little Ca++

222
Q

violent tissue death =

A

necrosis

223
Q

what is myocardial infarct

A

ischemic necrosis of myocardium

224
Q

what is coagulative necrosis and what is it seen in

A

“dry necrosis” basic cell outline maintained. Nuclei lost, cytoplasm eosinophil. Hypoxic cell death. (seen in infarcts)

225
Q

what is liquefactive necrosis and what is it seen in

A

“Liquid necrosis” tissue dissolves. every structure lost. no cells visible. brain shows liquefactive necrosis (seen in severe infections)

226
Q

what are the 3 clinical types of necrosis

A
  1. gangrene (gangrenous necrosis)
  2. caseous necrosis
  3. fat necrosis
227
Q

what is gangrene necrosis and examples

A
  1. dry or wet gangrene
  2. often after loss of blood supply –> coagulative necrosis

EX: diabetic foot, peripheral arterial disease, frost bite

228
Q

what is caseous necrosis

A

tuberculosis, lung cavity filled with “cheesy” white-yellowed material –> liquefactive necrosis

229
Q

what is fat necrosis

A

fat destruction of the mesentery (tissue-fat-sheet in the belly). frequently after pancreatitis

230
Q

IMPORTANT: the _____ usually shows _________ necrosis

A

BRAIN shows LIQUEFACTIVE NECROSIS

231
Q

what is a CAT scan

A

computer axial tomography

232
Q

what are the 3 types of lice

A
  1. head lice
  2. pubic lice
  3. body lice
233
Q

what is significant about body lice compared to other lice

A

body lice is the only one to spread infectious diseases

234
Q

medical procedures are considered invasive if they

A

break skin

235
Q

common lab tests include the following except
A. CBC
B. urine analysis
C. comprehensive metabolic panel (CMP)
D. paternity test

A

D. paternity test

236
Q

the following are all considered WBC except for
A. monocytes
B. platelets
C. granulocytes
D. lymphocytes

A

B. platelets

237
Q

T/F: leukocytosis is the increase in WBC

A

TRUE

238
Q

T/F: EKG measures electrical activity of brain

A

FALSE (MEASURES HEART)

239
Q

which of the following associations is correct?
A. thrombocytopenia - too low platelets
B. lymphocytosis - too few lymphocytes
C. leukocytosis - too low WBC
D. anemia - too many RBCs

A

A. thrombocytopenia - too low platelets

240
Q

what are the values of normal Hgb (hemoglobin), WBC, and Plt (platelets) in CBC fishbone

A

Hgb = 16
WBC = 8.9
Plt = 275

241
Q

what are the 5 WBC

A
  1. lymphocytes
  2. monocytes
  3. granulocytes
  4. neutrophils
  5. eosinophils
242
Q

what are the normal values in a 7 part fishbone

A
  1. Na = 135-145
  2. Cl = 97-107
  3. BUN = 8-21
  4. K = 3.5-5.0
  5. CO2 = 22-26
  6. Creat = 0.6-1.2
  7. Glu = 70-100
243
Q

what are the normal lab values in a 4 part fishbone

A
  1. WBC = 4.5-11
  2. Hgb = 12.0-17.5
  3. Hct = 34-52
  4. Plt = 150-450
244
Q

what are the normal lab values for a 3 part fishbone

A

PT = 10-13
PTT = 25-35
INR = 0.8-1.2

245
Q

what is considered the pacemaker in the electric conduction of the heart

A

Sinus Node (SA node)

246
Q

what is the gatekeeper of signals coming from SA node or atria

A

AV node

247
Q

what is the order of the electric conduction of the heart (NEEDS TO HAPPEN IN THIS ORDER)

A
  1. SA node fires
  2. atria start contracting
  3. signal goes to the AV node
  4. goes to tip of the heart
248
Q

what are the parts of an X-ray

A
  1. lead case
  2. cathode
  3. oil bath
  4. electron beam
  5. vacuum
  6. filter
  7. tungsten anode
  8. motor
  9. x-ray beam
249
Q

what is the recommended limit for radiation workers every five years in radiation reading, millisievert (mSv)

A

100.00 (equal to 1,000 chest x-rays)

250
Q

what is the lowest annual dose at which any increase in cancer is clearly evident in radiation reading, millisievert (mSv)

A

100.00 (equal to 1,000 chest x-rays)

251
Q

what is the radiation reading, millisievert (mSv) for CT scan: abdomen and pelvis

A

15.00

252
Q

what is the radiation reading, millisievert (mSv) for airline crew flying New York to Tokyo polar route, annual exposure

A

9.00

253
Q

what is the radiation reading, millisievert (mSv) for natural radiation we’re all exposed to per year

A

2.00 (equal to 20 chest x-rays)

254
Q

what is the radiation reading, millisievert (mSv) for a chest x-ray

A

0.10 (0.1 rem)

255
Q

what is the order of a simple epithelium (single layer)

A
  1. squamous
  2. cuboidal
  3. columnar
  4. pseudostratified
256
Q

what is the order of a stratified epithelium (arranged in sheets or layers)

A
  1. squamous
  2. cuboidal
  3. columnar
  4. transitional
257
Q

what is prostate hyperplasia

A

proliferation of glands. testosterone converted in prostate stromal cells to dihydrotestosterone (x10 more potent). nodular hyperplasia, BPH = benign prostatic hyperplasia. develop more cells = bigger prostate

258
Q

what is pathological diagnosis based on

A

macroscopic/microscopic changes

259
Q

T/F: Imhotep was a greek physician

A

FALSE (Egyptian)

260
Q

whose writings guided medicine for 1,500 years into the Middle Ages

A

Galen

261
Q

what are the 11 characteristics of lice

A
  1. size of sesame seed
  2. feed on human blood
  3. nits are glued to hair
  4. common young children
  5. spread by direct contact
  6. can’t jump or fly
  7. spot them behind ears
  8. easily treatable
  9. wash clothes with hot H2O
  10. put clothes in hot dryer
  11. can affect everyone
262
Q

T/F: signs and symptoms can either be seen of measured by medical imaging/testing

A

FALSE (SYMPTOMS CAN’T BE SEEN OR MEASURED)

263
Q

the shorter the wavelength the ______ the _____

A

higher the energy

264
Q

what is inflammation

A

a mechanism to protect an organism from danger

265
Q

where does the danger inflammation tries to protect come from

A

invading pathogens (infection) or tissue damage through other means (necrotic tissue death)

266
Q

what is inflammation meant to do

A

eliminate the source of danger, restrict its extent (wall off), and help repair the damage

267
Q

inflammation has two components what are they

A
  1. vascular component
  2. cellular component
268
Q

how can one distinguish between acute and chronic inflammation

A

based on the timing and the involved cells

269
Q

the inflammatory response varies to a certain degree between…

A

tissues and organs

270
Q

what happens WITHOUT preexisting immunity

A

preformed mechanisms and innate immunity are the first line of defense

271
Q

what happens WITH preexisting immunity

A

adaptive immunity (EX: antibodies) facilitates activation of defense mechanisms

272
Q

what is the order of events for inflammation

A

ALERT -> WALL OFF -> DESTROY -> REPAIR

1st: ALARM the body that something is going on

2nd: WALL OFF and prevent the spread of the pathogens from the entrance site to the blood and other tissues

3rd: bring “troops” to the site of action to DESTROY danger

4th: set stage for REPAIR by growing blood vessels and proliferate fibroblasts

273
Q

inflammation cannot (should) not…

A

go on indefinitely

274
Q

when is the inflammatory supposed to stop

A

when the offender is eliminated

275
Q

there are specific mechanisms that _____/_____ an inflammatory process

A

terminate/restrict

276
Q

what is the end goal of the inflammatory process

A

not to eliminate the offender at the cost of destroying the host

277
Q

different tissues = ?

A

different inflammatory responses

278
Q

what are the events that trigger inflammation

A
  1. infections
  2. trauma (injury)
    • mechanical injury
    • physical injury (heat, frostbite)
    • chemicals
    • foreign bodies
  3. tissue necrosis
  4. immune reactions (for EX: in hypersensitivity disorders
279
Q

what are the big players for inflammation

A
  1. blood vessels
  2. inflammatory cells
  3. vasoactive factors (EX: histamine, bradykinins)
  4. complement system
  5. blood clotting system
280
Q

how do microbes enter tissue

A

through breach in the skin

281
Q

what are microbes coated with

A

antibodies and/or complements

282
Q

what happens to antibodies in inflammatory events after infection

A

antibodies bind complement, complement factors are cleaved and complement cascade is activated

283
Q

what are two important complement factors and what do they do after infection

A

C3a and C5a activate other cells, such as tissue mast cells

284
Q

what two vasoactive factors do tissue mast cells release and what are they

A
  1. Histamine = short acting vasodilator, released early
  2. Bradykinin = released later, long acting vasodilator
285
Q

what do vasodilators do after infection

A

increase blood flow into tissues, but speed of blood flow slows down in affected areas

286
Q

what happens to immune cells in inflammatory events after infection

A

they become recruited and activated

first cells = neutrophils
next: macrophages/DC. they release factors that induce additional defensive mechanisms, such as fever (CNS) and acute phase proteins (liver)

287
Q

what are the central players in inflammation

A

blood vessels (vascular dilation and permeability)

288
Q

what happens to a lesion when there is an increase blood flow

A

lesion turns red and warm (rubor and calor)

289
Q

what can produce vasoactive mediators

A

inflammatory and noninflammatory cells

290
Q

what are the mediators inducing vascular dilation what do they do

A

Histamine, nitric oxide, Bradykinin, prostaglandins, serotonin

primarily act on arterioles (very small arteries) –> more in, less out

291
Q

what are the mediators that increase vascular permeability

A

Histamine, bradykinin, serotonin, and complement factors (C3a, C5a)

292
Q

what is the normal state of vascular changes

A
  • no fluid excess in tissues
  • lymphatic vessels drain excess fluid from tissues
293
Q

what occurs in vascular changes during inflammation

A

more blood flow and fluid leaks into tissues

294
Q

what triggers key tissue events in acute inflammation

A

vascular dilation

295
Q

what does altered blood flow create in vascular dilation

A

creates “turbulence” of blood cells (marginalization) = inflammatory cells leave the blood stream and migrate into tissues

296
Q

in vascular dilation, what happens when there is increased oxygen demand by cells

A

it lowers tissue oxygen levels

297
Q

in vascular dilation, what happens when there is decreased oxygen in tissues

A

this results in lower (acidic) pH in inflamed region = inflammatory enzymes work better

298
Q

in vascular dilation, what does altered blood flow promote

A

blood clot formation to stop bleeding and wall of injury

299
Q

what 2 things occur in enhanced vascular permeability

A
  1. inflammatory proteins can get into injured tissue
  2. inflammatory cells can easier migrate through vessel walls
300
Q

what are characteristics of transudate

A
  1. low in protein, <30g/L; specific gravity < 1.012; clear
  2. congestive heart failure
  3. cirrhosis
  4. kidney disease
301
Q

what are characteristics of exudate

A
  1. high in protein, >30g/L, specific gravity > 1.020; cloudy
  2. infections, pneumonia, Tb, malignancy, pulmonary embolism
302
Q

what is light’s criteria

A

used to differentiate between transudate and exudate “Fluid” protein to serum protein ratio > 0.5 = exudate

303
Q

what is edema

A

transudate or exudate in tissue or body cavities

303
Q

what is pus

A

fluid contains many leukocytes (neutrophils, macrophages)

304
Q

what is important to alert immune defenses and destroy microbes

A

antibodies and complement

305
Q

complement system consists of…

A

over 30 proteins

306
Q

what is the sequential order of the complements

A

C1 -> C2a/C4b -> C3 -> C5, C6, C7, C8, C9

307
Q

what is the central molecule complement

A

C3

308
Q

what complements serve as soluble signs for other cells

A

C3a and C5a

309
Q

where do inflammatory cells migrate to

A

sites of inflammation in a defined sequence of steps

310
Q

inflammatory mediators produced by _____ and _____ have _____ effects

A

phagocytes and liver have systemic events

311
Q

acute phase reactants trigger…

A

acute phase response

312
Q

what are the acute phase reactants for positive response

A

“positive” = pro inflammatory

  1. C-reactive protein (CRP)
  2. Serum amyloid A (SAA)
  3. Complement (C3, C4)
  4. Fibrinogen
  5. mostly made by liver
313
Q

what are the acute phase reactants for negative acute phase response

A

“negative” = anti-inflammatory

  1. transferrin
  2. albumin
314
Q

what are systemic changes during acute inflammation called

A

acute phase response

315
Q

what is a fever induced by

A

endogenous pyrogens (IL-1, TNF) that induce PGE2 via enhancement of cyclooxyrgenase-2

316
Q

what do acute phase proteins (EX: CRP, SAA) help in

A

defense against infection

317
Q

leukocytosis involves what WBCs

A

neutrophilia, lymphocytosis, eosinophilia

318
Q

increased pulse =

A

enhanced blood pressure

319
Q

what are the 4 systemic effects of inflammation

A
  1. FEVER
  2. LEUKOCYTOSIS
  3. INCREASED PULSE
  4. CHILLS, MALAISE
320
Q

what are examples of very severe change in the systemic effects of inflammation

A
  1. septic shock syndrome
  2. disseminated intravascular coagulation (DIC)
321
Q

fever = ?

A

pyrexia

322
Q

a person is considered to have a fever when what 3 things occur

A
  1. rectal temp (anal) = 38°C or higher (100.4°F)
  2. oral temp (mouth) = 37.5°C or higher (99.5°F)
  3. axillary temp (armpits) = 37.2°C or higher (99°F)
323
Q

what are the 4 ways a fever is graded

A
  1. low grade: 38-39°C (99.5-102.2°F)
  2. moderate: 39-40°C (102.2-104°F)
  3. high grade: >40°C (>104°F)
  4. hyperpyrexia: >42°C (>107.6°F)
324
Q

what is Forsthuber’s conversion trick

A

40°C = 104°F –> -2°F = -1°C

325
Q

what is involved with acute inflammation

A
  1. neutrophils
  2. necrosis
  3. edema
  4. dilated vessels
326
Q

what is involved with chronic inflammation

A
  1. lymphocytes
  2. fibrosis
  3. changes in tissue architecture
327
Q

what is inflammation usually associated with

A

damage/dead tissue

328
Q

what is the potential source of infection and what does it do

A

dead tissue and impairs tissue repair

329
Q

dead tissue must be ____ and/or ____

A

removed and/or repaired

330
Q

how can damaged tissues be replaced

A

completely replaced (“like new”) or replaced by a scar (“cheap” replacement)

331
Q

tissue repair must be…

A

well controlled

332
Q

what can happen if tissue repair is excessive

A

new medical issues may arise (EX: excess scar formation = keloid or liver cirrhosis)

333
Q

what can be the result if inflammatory stimulus is ongoing

A

fibrosis (EX: liver cirrhosis)

334
Q

what is tissue regeneration and are 4 key points about it

A

tissue regeneration = lost tissue re-grows

  1. occurs in tissues with high turnover - skin, gut, bone marrow
  2. rarely occurs in organs, except for the liver (and kidney)
  3. depends on intact tissue scaffold
  4. requires that “tissue stem cells survive”
335
Q

what are key points for tissue healing

A
  1. healing is a combination of regeneration and scar formation
  2. scar formation is the replacement of original tissue with fibrous tissue
336
Q

so tissues like the ____ can ____

A

liver can regenerate

337
Q

what can regenerate completely

A

GI and skin epithelium

338
Q

what does regeneration and healing require

A

tissue stem cells

339
Q

what are macrophages in wound healing

A

architects of wound healing/tissue repair via cytokines and growth factors

340
Q

what orchestrates wound healing

A

cytokines and growth factors

341
Q

what do growth factors affect

A
  1. cell proliferation
  2. cell migration
  3. angiogenesis (growth of blood vessels)
  4. tissue matrix formation
  5. deposit of collagen (fibrosis)
342
Q

what are 2 important growth factors

A
  1. transforming growth factor beta (TGF-b, fibrosis)
  2. vascular endothelial growth factor (VEGF, vessels)
343
Q

what type of process is wound healing

A

multistep process

344
Q

what is the first phase of wound healing

A

1st phase = inflammatory phase
- removal of damaged/dead tissue

345
Q

what are characteristics of healing by first intention

A
  1. edges are close, not infected
  2. proper epithelialization of wound surface
  3. angiogenesis
  4. fibroblast proliferation and collagen deposition
  5. remodeling
  6. as good as new - maybe not even scar
  7. uncomplicated wound
346
Q

what are characteristics of healing by second intention

A
  1. complicated wound
  2. wound has larger gaps (infected wound, more tissue, damage, foreign body)
  3. more inflammation
  4. more granulation tissue
  5. wound contraction becomes important = mediated by myofibroblasts that contract at the edges
  6. healing is usually less perfect and leaves scar = fibrous tissue, thinner epithelial cover
347
Q

what is locally impaired wound healing

A
  1. impaired perfusion
  2. infection
  3. foreign body
  4. hematomas
  5. denervation
  6. necrotic tissue
  7. mechanical stress
  8. type of tissue
  9. surgical technique
348
Q

what is systemic impaired wound healing

A
  1. age
  2. pre-existing conditions (diabetes, malnutrition, atherosclerosis, drugs (steroids, chemotherapy)
  3. genetic disorders
  4. trauma
  5. vitamin deficiency
349
Q

what happened when healing is incomplete

A

deficient scar

350
Q

what is wound dehiscence

A

edges of the wound separate

351
Q

what is ulcer formation

A

wound does not heal (not epithelialized)

352
Q

what is a hypertrophic scar

A

raised scar tissue that remains within boundaries of the original wound

353
Q

what is a keloid

A

overgrowth of scare tissue beyond original wound

354
Q

what is an aggressive scar

A

desmoid tumors (aggressive fibromatosis) benign tumors but can grow aggressively and even invade surrounding tissues. NOT cancer and does not metastasize

355
Q

what are contractures

A

after burns

356
Q

what is the 2nd phase of wound healing

A

2nd phase = proliferative phase
- angiogenesis (new blood vessel formation)
- granulation tissue formation
- wound contraction (myofibroblasts)

357
Q

what is the 3rd phase of wound healing

A

3rd phase = maturation phase
- tissue remodeling (collagen)
- removal of unneeded cells (apoptosis)
- reconstruction of the extracellular matrix

358
Q

T/F: CT creates more radiation exposure than regular X-ray

A

TRUE

359
Q

which of the following statements about staining of tissues for histopathology is correct

a. H&E stains visualize nucleus and cytoplasm

b. “H” in H&E stands for hematoxylin

c. “E” in H&E stands for eosin

d. all of the above

A

d. all of the above

360
Q

T/F: MRI uses strong magnets and radio waves to generate detailed images of internal organs and tissues

A

TRUE

361
Q

which of the following statements about ultrasound is correct

a. ultrasound has high frequency sound waves (> 20,000 Hz)

b. humans can’t hear the ultrasound waves

c. can detect heart conditions, blood vessels, and internal organs

d. all of the above

A

d. all of the above

362
Q

T/F: histology preserves tissue architecture whereas cytology doesn’t not

A

TRUE

363
Q

T/F: T1 is better for anatomy and T2 is better for pathology

A

TRUE

364
Q

the MRI mnemonic WW2 refers to

a. Wonder Woman 2 - T2 is brighter
b. World War 2 - water is white in T2
c. without weather 2 - T1 shows bone
d. all are correct

A

b. World War 2 - water is white in T2

365
Q

what is munchausen syndrome

A

a fabricated illness to gain attention and sympathy

366
Q

what are key points of manchausen syndrome

A
  1. psychiatric disorder where patients fake and induce illness to gain sympathy
  2. also known as hospital hopper, thick chart syndrome, hospital addiction syndrome
  3. patient harm themselves
  4. patients are knowledgable, go through multiple doctors or hospitals
  5. when others are harmed = “munchausen syndrome by proxy”
  6. munchausen is NOT malingering (no financiall gain)
367
Q

who created munchausen syndrome

A

its of German background based on Baron von Munchausen (1720-1797) who wrote a book of stories based on his imaginary adventures

368
Q

which association is wrong?

a. transudate = fluid low in protein
b. edema = transudate or exudate
c. exudate = fluid low in protein
d. pus = fluid rich in leukocytes

A

c. exudate = fluid low in protein

369
Q

T/F: metaplasia increases risk of cancer

A

TRUE

370
Q

which statement about complement is wrong

a. complement system consists of many diff proteins

b. complement activation recruits inflammatory cells

c. three pathways activate complement system

d. compliment activation leads to release of C3b

A

d. compliment activation leads to release of C3b

371
Q

which conversion is wrong

a. 102°F = 39°C
b. 37°C = 100°F
c. 104°F = 40°C
d. 42°C = 108°F

A

b. 37°C = 100°F

372
Q

what is the correct order of wound healing

a. inflammatory - proliferative - maturation

b. proliferative - inflammatory - maturation

c. maturation - inflammatory - proliferative

d. inflammatory - maturation - proliferative

A

a. inflammatory - proliferative - maturation

373
Q

what three pathways activate the complement system

A
  1. alternate pathway
  2. classical pathway
  3. lectin pathway
374
Q

T/F: the brain typically shows coagulation type necrosis

A

FALSE

375
Q

T/F: wound healing has three phases

A

TRUE

376
Q

which statement about cell death is correct?

a. apoptosis can be classified into three different mechanisms

b. necrotic cell death typically causes an inflammatory response

c. apoptotic cell death typically does not cause inflammation

d. all of the above

A

d. all of the above

377
Q

which of the following does not act on blood vessels

a. histamine
b. hemostatin
c. bradykinin
d. nitric oxide

A

b. hemostatin

378
Q

what are examples of non-keratinized stratified epithelium

A
  1. cornea
  2. mouth
  3. rectum
  4. vagina
  5. esophagus
379
Q

what are examples of keratinized stratified epithelium

A
  1. skin
  2. tongue
  3. lips
380
Q

what is a normal temperature and who was it reported by

A

37°C (98.6°F) reported by German physician Carl Wunderlich in 1851

381
Q

what is the average temperature for humans

A

36.6°C or ~98°F (97.8 exact)

382
Q

what are the three mechanisms for apoptosis

A
  1. extrinsic = death receptor mediated
  2. intrinsic = mitochondria mediated
  3. endoplasmic reticulum stress pathway = mediated by too much or too little Ca2+
383
Q

what years were Rudolf Virchow active

A

1821-1905

384
Q

what is the mnemonic for ECG strip

A

DOG AND THE COOKIE

show dog cookie = jumps up (large spike (QRS)

dog doesn’t see treat = normal wave (P)

take away the treat = sad and down (small hump = T wave)

385
Q

what does the black and white image of an X-ray indicate

A

black = less dense tissue
white = dense tissue

386
Q

what eats apoptotic cells

A

phagocytes

INTRO TO CLINICAL (2 decks)

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